Abstract
Background
The demonstration of competency in endoscopy is required prior to obtaining American Board of Surgery Certification. To demonstrate competency, the resident must pass a national high-stakes cognitive test and a technical skills exam on a virtual reality simulator. The purpose of this preliminary study was to design a proficiency-based endoscopy simulation curriculum to meet this competency requirement.
Methods
This is a mixed methods prospective cohort study at a single academic medical institution. Prior to taking the national exam, surgery residents were required to participate in a skills lab and demonstrate proficiency on 10 simulation tasks. Proficiency was based on time and percent of objects targeted/mucosa seen. Simulation practice time, number of task repetitions to proficiency, and prior endoscopic experience were recorded. Resident’s self-reported confidence scores in endoscopic skills prior to and following simulation lab training were obtained.
Results
From January 1, 2016 through August 1, 2017, 20 surgical residents (8 PGY2, 8 PGY3, 4 PGY4) completed both a faculty-supervised endoscopy skills lab and independent learning with train-to-proficiency simulation tasks. Median overall simulator time per resident was 306 min (IQR: 247–405 min). Median overall time to proficiency in all tasks was 235 min (IQR: 208–283 min). The median time to proficiency decreased with increasing PGY status (r = 0.4, P = 0.05). There was no correlation between prior real-time endoscopic experience and time to proficiency. Reported confidence in endoscopic skills increased significantly from mean of 5.75 prior to 7.30 following the faculty-supervised endoscopy skills lab (P = 0.0002). All 20 residents passed the national exam.
Conclusions
In this preliminary study, a train-to-proficiency curriculum in endoscopy improved surgical resident’s confidence in their endoscopic skills and 100% of residents passed the FES technical skills test on their first attempt. Our findings also indicate that uniform proficiency was not achieved by real-time experience alone.
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Drs. Susan Gearhart, Michael Marohn, Saowanee Ngamruengphong, Gina Adrales, Oluwafemi Owodunni, Kim Duncan, Emil Petrusa, and Pamela Lipsett have no conflicts of interest or financial ties to disclose.
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Gearhart, S., Marohn, M., Ngamruengphong, S. et al. Development of a train-to-proficiency curriculum for the technical skills component of the fundamentals of endoscopic surgery exam. Surg Endosc 32, 3070–3075 (2018). https://doi.org/10.1007/s00464-017-6018-7
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DOI: https://doi.org/10.1007/s00464-017-6018-7